3D打印模板引导^(125)I放射性粒子组织间植入恶性肿瘤的临床应用  

Clinical application of 3D printing template-assisted ^(125)I radioactive seed interstitial brachytherapy in treating malignant tumors

作　　者：潘天帆 陆建[1] 王勇[1] 朱光宇[1] 陈荔[1] 郭金和[1] PAN Tianfan;LU Jian;WANG Yong;ZHU Guangyu;CHEN Li;GUO Jinhe(Department of Interventional Radiology and Vascular Surgery,Affiliated Zhongda Hospital,Southeast University,Nanjing,Jiangsu Province 210009,China)

机构地区：[1]东南大学附属中大医院介入与血管外科,南京210009

出　　处：《介入放射学杂志》2018年第8期740-744,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金(81471762);江苏省省级重点研发专项资金(BE2016783)

摘　　要：目的探讨3D打印模板联合CT引导125I放射性粒子组织间植入治疗恶性肿瘤的准确性和安全性。方法回顾分析2016年3月—2017年6月行3D打印模板联合CT引导125I粒子植入恶性肿瘤患者30例,术后即刻对植入质量进行评价,评价标准采用英国哥伦比亚癌症研究中心(British Columbia Cancer Agency,BCCA)标准,根据术后验证靶区D90和V100评价为优、良、中、差4组,对比手术前后靶区体积和D90、D100、V100、V150等剂量学参数,观察术中及术后近期并发症情况。统计学采用配对t检验。结果术后验证评价结果:优:24例(83.3%,24/30);良:5例(16.7%,5/30);中:1例(3.3%,1/30);差:0例(0)。术前计划靶体积(planning target volume,PTV)的范围是15.9～265.5 cc,平均为(64.4±58.4)cc;术后验证PTV范围是18.5～267.8 cc,平均(64.4±58.4)cc,两者比较差异有统计学意义(P<0.05)。术前D90、D100、V150分别为(11 945.6±1 157.0)cGy、(6 972.7±1 250.5)cGy、(58.0±4.4)%,术后分别为(11 839.0±1 117.0)cGy、(7 352.1±1 361.2)cGy、(57.6±4.1)%。上述指标手术前后比较差异均无统计学意义(均P>0.05)。术前V100为(91.1±1.8)%,术后V100为(90.5±1.6)%,两者比较差异有统计学意义(P<0.05)。术中及术后24 h内可观察到3例气胸,1例少量咯血,经保守治疗后好转。25例于拔针后局部少量出血,经局部压迫后止血。余未见其他手术相关并发症。结论 3D打印模板联合CT引导125I粒子植入治疗实体恶性肿瘤可较好完成术前计划,植入质量较满意,治疗相关近期不良反应较少,可作为不可手术的恶性肿瘤治疗的一种选择。Objective To evaluate the accuracy and safety of 3D printing template-assisted CT-guided ^（125） I radioactive seed interstitial brachytherapy in treating malignant tumors. Methods The clinical data of 30 patients with malignant tumor, who received 3D printing template-assisted CT-guided ^（125） I radioactive seed interstitial brachytherapy during the period from March 2016 to June 2017, were retrospectively analyzed. Immediately after the operation, the quality of ^（125） I seed implantation was evaluated using BCCA（British Columbia Cancer Agency） criterion. Based on the postoperative D90 and V100 of the verification target regions, the patients were divided into four groups： excellent group, good group, moderate group, and poor group. The volume of target area and the dosimetry parameters, including D90, D100, V100 and V150, were measured before and after the treatment, and the results were compared between preoperative data and postoperative ones. The intraoperative and postoperative complications were recorded. Paired t-test was used to make statistical analysis. Results Postoperative evaluation indicated that 24 patients（80.0%, 24/30） belonged to the excellent group, 5 patients（16.7%,5/30） to the good group, one patient（3.3%,1/30）to the moderate group, and no patient to the poor group. The range of preoperative planning target volume（PTV） was（15.9-265.5） cc, with a mean of（64.4±58.4） cc; the postoperative verification range of PTV was（18.5-267.8） cc, with a mean of（64.4±58.4） cc; the difference between the two was statistically significant（P〈0.05）. The preoperative D90, D100, and V150 were（11 945.6±1 157.0） c Gy,（6 972.7±1 250.5） c Gy and（58.0±4.4）% respectively, and the postoperative D90, D100, and V150 were（11 839.0±1 117.0） c Gy,（7 352.1±1 361.2） c Gy and（57.6 ±4.1）% respectively, the differences in the above indexes between the two were not statistically significant（all P〈0.05）. The preoperative V100 was（91.1 ±1

关 键 词：3D打印模板 ^125I粒子 近距离放射治疗 恶性肿瘤 

分 类 号：R735[医药卫生—肿瘤]